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Verdejo-Garcia A, Rezapour T, Giddens E, Khojasteh Zonoozi A, Rafei P, Berry J, Caracuel A, Copersino ML, Field M, Garland EL, Lorenzetti V, Malloy-Diniz L, Manning V, Marceau EM, Pennington DL, Strickland JC, Wiers R, Fairhead R, Anderson A, Bell M, Boendermaker WJ, Brooks S, Bruno R, Campanella S, Cousijn J, Cox WM, Dean AC, Ersche KD, Franken I, Froeliger B, Gamito P, Gladwin TE, Goncalves PD, Houben K, Jacobus J, Jones A, Kaag AM, Lindenmeyer J, McGrath E, Nardo T, Oliveira J, Pennington CR, Perrykkad K, Piercy H, Rupp CI, Schulte MHJ, Squeglia LM, Staiger P, Stein DJ, Stein J, Stein M, Stoops WW, Sweeney M, Witkiewitz K, Woods SP, Yi R, Zhao M, Ekhtiari H. Cognitive training and remediation interventions for substance use disorders: a Delphi consensus study. Addiction 2023; 118:935-951. [PMID: 36508168 PMCID: PMC10073279 DOI: 10.1111/add.16109] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 11/23/2022] [Indexed: 12/14/2022]
Abstract
AIMS Substance use disorders (SUD) are associated with cognitive deficits that are not always addressed in current treatments, and this hampers recovery. Cognitive training and remediation interventions are well suited to fill the gap for managing cognitive deficits in SUD. We aimed to reach consensus on recommendations for developing and applying these interventions. DESIGN, SETTING AND PARTICIPANTS We used a Delphi approach with two sequential phases: survey development and iterative surveying of experts. This was an on-line study. During survey development, we engaged a group of 15 experts from a working group of the International Society of Addiction Medicine (Steering Committee). During the surveying process, we engaged a larger pool of experts (n = 54) identified via recommendations from the Steering Committee and a systematic review. MEASUREMENTS Survey with 67 items covering four key areas of intervention development: targets, intervention approaches, active ingredients and modes of delivery. FINDINGS Across two iterative rounds (98% retention rate), the experts reached a consensus on 50 items including: (i) implicit biases, positive affect, arousal, executive functions and social processing as key targets of interventions; (ii) cognitive bias modification, contingency management, emotion regulation training and cognitive remediation as preferred approaches; (iii) practice, feedback, difficulty-titration, bias modification, goal-setting, strategy learning and meta-awareness as active ingredients; and (iv) both addiction treatment work-force and specialized neuropsychologists facilitating delivery, together with novel digital-based delivery modalities. CONCLUSIONS Expert recommendations on cognitive training and remediation for substance use disorders highlight the relevance of targeting implicit biases, reward, emotion regulation and higher-order cognitive skills via well-validated intervention approaches qualified with mechanistic techniques and flexible delivery options.
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Affiliation(s)
- Antonio Verdejo-Garcia
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Clayton, VIC, Australia
| | - Tara Rezapour
- Department of Cognitive Psychology, Institute for Cognitive Science Studies, Tehran, Iran
| | - Emily Giddens
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Clayton, VIC, Australia
| | - Arash Khojasteh Zonoozi
- Iranian National Center for Addiction Studies, Tehran University of Medical Sciences, Tehran, Iran
| | - Parnian Rafei
- Iranian National Center for Addiction Studies, Tehran University of Medical Sciences, Tehran, Iran
| | - Jamie Berry
- Faculty of Medicine and Health Sciences, Macquarie University, Macquarie Park, NSW, Australia
| | - Alfonso Caracuel
- Mind, Brain and Behavior Research Center, Universidad de Granada, Granada, Spain
| | | | - Matt Field
- Department of Psychology, University of Sheffield, Sheffield, UK
| | - Eric L Garland
- Center on Mindfulness and Integrative Health Intervention Development, University of Utah, Salt Lake City, UT, USA
| | - Valentina Lorenzetti
- Neuroscience of Addiction and Mental Health Program, Healthy Brain and Mind Research Centre, School of Behavioral Sciences, Faculty of Health Sciences, Australian Catholic University, Melbourne, VIC, Australia
| | - Leandro Malloy-Diniz
- Mental Health Department, Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Victoria Manning
- Turning Point Drug and Alcohol Centre and Monash Addiction Research Centre (MARC), Monash University, Melbourne, VIC, Australia
| | - Ely M Marceau
- School of Psychology and Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW, Australia
| | - David L Pennington
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, USA
| | - Justin C Strickland
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Reinout Wiers
- Addiction Development and Psychopathology (ADAPT) Laboratory, Department of Psychology, Centre for Urban Mental Health, University of Amsterdam, Amsterdam, the Netherlands
| | - Rahia Fairhead
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Clayton, VIC, Australia
| | - Alexandra Anderson
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Clayton, VIC, Australia
| | - Morris Bell
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Wouter J Boendermaker
- Addiction, Development, and Psychopathology (ADAPT) Laboratory, Department of Psychology, University of Amsterdam, Amsterdam, the Netherlands
| | - Samantha Brooks
- Research Centre for Brain and Behaviour, School of Psychology, Faculty of Health, Liverpool John Moores University, UK
| | - Raimondo Bruno
- School of Psychology, University of Tasmania, TAS, Hobart, Australia
| | - Salvatore Campanella
- Laboratoire de Psychologie Médicale et d'Addictologie, ULB Neuroscience Institute (UNI), CHU Brugmann-Université Libre de Bruxelles, Bruxelles, Belgium
| | - Janna Cousijn
- Department of Psychology, Education and Child Studies, Erasmus University Rotterdam, the Netherlands
| | - W Miles Cox
- School of Human and Behavioural Sciences, Bangor University, Bangor, UK
| | - Andrew C Dean
- Department of Psychiatry and Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, CA, USA
| | - Karen D Ersche
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Ingmar Franken
- Department of Psychology, Education and Child Studies, Erasmus University Rotterdam, the Netherlands
| | - Brett Froeliger
- Department of Psychiatry and Psychological Sciences, University of Missouri, Columbia, MO, USA
| | | | | | - Priscila D Goncalves
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Katrijn Houben
- Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Joanna Jacobus
- Department of Psychiatry, University of California San Diego, CA, USA
| | - Andrew Jones
- Department of Psychology, University of Liverpool, UK
| | - Anne M Kaag
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, the Netherlands
| | | | - Elly McGrath
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Talia Nardo
- School of Psychological Sciences, Macquarie University, NSW, Australia
| | | | | | - Kelsey Perrykkad
- Cognition and Philosophy Laboratory, Monash Centre for Consciousness and Contemplative Studies, Monash University, Melbourne, VIC, Australia
| | - Hugh Piercy
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, VIC, Australia
| | - Claudia I Rupp
- Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology, University Clinics of Psychiatry I, Medical University Innsbruck, Innsbruck, Austria
| | - Mieke H J Schulte
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, the Netherlands
| | - Lindsay M Squeglia
- Department of Psychiatry, Medical University of South Carolina, Charleston, SC, USA
| | - Petra Staiger
- School of Psychology, Deakin University, Melbourne, VIC, Australia
| | - Dan J Stein
- SAMRC Unit on Risk and Resilience in Mental Disorders, Department of Psychiatry and Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Jeff Stein
- Center for Health Behaviors Research, Fralin Biomedical Research Institute at Virginial Tech, VA, USA
| | - Maria Stein
- Department for Clinical Psychology and Psychotherapy, University of Bern, Switzerland
| | - William W Stoops
- Department of Behavioral Science, University of Kentucky, Lexington, KY, USA
| | - Mary Sweeney
- Behavioral Pharmacology Research Unit, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Katie Witkiewitz
- Department of Psychology and Center on Alcohol, Substance Use and Addictions, University of New Mexico, NM, USA
| | - Steven P Woods
- Department of Psychology, University of Houston, Houston, TX, USA
| | - Richard Yi
- Department of Psychology, University of Kansas, Lawrence, KS, USA
| | - Min Zhao
- Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Hamed Ekhtiari
- Department of Psychiatry, University of Minnesota, Minneapolis, MN, USA
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2
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Amarti K, Schulte MHJ, Kleiboer A, Van Genugten CR, Oudega M, Sonnenberg C, Gonçalves GC, Rocha A, Riper H. Feasibility of Digital Cognitive Behavioral Therapy for Depressed Older Adults With the Moodbuster Platform: Protocol for 2 Pilot Feasibility Studies. JMIR Res Protoc 2022; 11:e41445. [PMID: 36282565 PMCID: PMC9644251 DOI: 10.2196/41445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 09/30/2022] [Accepted: 09/30/2022] [Indexed: 11/25/2022] Open
Abstract
Background Internet-based interventions can be effective in the treatment of depression. However, internet-based interventions for older adults with depression are scarce, and little is known about their feasibility and effectiveness. Objective To present the design of 2 studies aiming to assess the feasibility of internet-based cognitive behavioral treatment for older adults with depression. We will assess the feasibility of an online, guided version of the Moodbuster platform among depressed older adults from the general population as well as the feasibility of a blended format (combining integrated face-to-face sessions and internet-based modules) in a specialized mental health care outpatient clinic. Methods A single-group, pretest-posttest design will be applied in both settings. The primary outcome of the studies will be feasibility in terms of (1) acceptance and satisfaction (measured with the Client Satisfaction Questionnaire-8), (2) usability (measured with the System Usability Scale), and (3) engagement (measured with the Twente Engagement with eHealth Technologies Scale). Secondary outcomes include (1) the severity of depressive symptoms (measured with the 8-item Patient Health Questionnaire depression scale), (2) participant and therapist experience with the digital technology (measured with qualitative interviews), (3) the working alliance between patients and practitioners (from both perspectives; measured with the Working Alliance Inventory–Short Revised questionnaire), (4) the technical alliance between patients and the platform (measured with the Working Alliance Inventory for Online Interventions–Short Form questionnaire), and (5) uptake, in terms of attempted and completed modules. A total of 30 older adults with mild to moderate depressive symptoms (Geriatric Depression Scale 15 score between 5 and 11) will be recruited from the general population. A total of 15 older adults with moderate to severe depressive symptoms (Geriatric Depression Scale 15 score between 8 and 15) will be recruited from a specialized mental health care outpatient clinic. A mixed methods approach combining quantitative and qualitative analyses will be adopted. Both the primary and secondary outcomes will be further explored with individual semistructured interviews and synthesized descriptively. Descriptive statistics (reported as means and SDs) will be used to examine the primary and secondary outcome measures. Within-group depression severity will be analyzed using a 2-tailed, paired-sample t test to investigate differences between time points. The interviews will be recorded and analyzed using thematic analysis. Results The studies were funded in October 2019. Recruitment started in September 2022. Conclusions The results of these pilot studies will show whether this platform is feasible for use by the older adult population in a blended, guided format in the 2 settings and will represent the first exploration of the size of the effect of Moodbuster in terms of decreased depressive symptoms. International Registered Report Identifier (IRRID) PRR1-10.2196/41445
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Affiliation(s)
- Khadicha Amarti
- Clinical Psychology Section, Department of Clinical, Neuro- and Developmental Psychology, Vrije Universiteit, Amsterdam, Netherlands
- Amsterdam Public Health Research Institute, Vrije Universiteit, Amsterdam, Netherlands
| | - Mieke H J Schulte
- Clinical Psychology Section, Department of Clinical, Neuro- and Developmental Psychology, Vrije Universiteit, Amsterdam, Netherlands
- Amsterdam Public Health Research Institute, Vrije Universiteit, Amsterdam, Netherlands
| | - Annet Kleiboer
- Clinical Psychology Section, Department of Clinical, Neuro- and Developmental Psychology, Vrije Universiteit, Amsterdam, Netherlands
- Amsterdam Public Health Research Institute, Vrije Universiteit, Amsterdam, Netherlands
| | - Claire Rosalie Van Genugten
- Clinical Psychology Section, Department of Clinical, Neuro- and Developmental Psychology, Vrije Universiteit, Amsterdam, Netherlands
- Amsterdam Public Health Research Institute, Vrije Universiteit, Amsterdam, Netherlands
| | - Mardien Oudega
- Amsterdam Universitair Medisch Centrum, Vrije Universiteit, Public Health Research Institute and Neuroscience Amsterdam, Amsterdam, Netherlands
- Department of Old Age Psychiatry, Geestelijk Gezondheidszorg inGeest Specialized Mental Health Care, Amsterdam, Netherlands
| | - Caroline Sonnenberg
- Amsterdam Universitair Medisch Centrum, Vrije Universiteit, Public Health Research Institute and Neuroscience Amsterdam, Amsterdam, Netherlands
- Department of Old Age Psychiatry, Geestelijk Gezondheidszorg inGeest Specialized Mental Health Care, Amsterdam, Netherlands
| | - Gonçalo C Gonçalves
- Institute for Systems and Computer Engineering, Technology and Science, Porto, Portugal
| | - Artur Rocha
- Institute for Systems and Computer Engineering, Technology and Science, Porto, Portugal
| | - Heleen Riper
- Clinical Psychology Section, Department of Clinical, Neuro- and Developmental Psychology, Vrije Universiteit, Amsterdam, Netherlands
- Amsterdam Public Health Research Institute, Vrije Universiteit, Amsterdam, Netherlands
- Department of Old Age Psychiatry, Geestelijk Gezondheidszorg inGeest Specialized Mental Health Care, Amsterdam, Netherlands
- Institute of Telepsychiatry, University of Southern Denmark, Odense, Denmark
- Faculty of Medicine, University of Turku, Turku, Finland
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Schulte MHJ, Goudriaan AE, Boendermaker WJ, van den Brink W, Wiers RW. The effect of N-acetylcysteine and working memory training on glutamate concentrations in the dACC and rACC in regular cocaine users - A randomized proof of concept study. Neurosci Lett 2021; 762:136146. [PMID: 34332028 DOI: 10.1016/j.neulet.2021.136146] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 06/24/2021] [Accepted: 07/26/2021] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Current treatments for cocaine use disorder (CUD) are not very effective and better treatments are needed. This study investigates the effectiveness of a combined intervention that targets the assumed underlying glutamate pathology in cocaine users. To this end, the combined effects of N-acetylcysteine (NAC) and working memory (WM) training on glutamate concentrations in the dorsal and rostral ACC were investigated in a randomized, double-blind placebo-controlled design. METHODS In this study, 38 regular cocaine-using men were randomized to either 25-days with 2400 mg/day NAC and WM-training or 25 days with placebo with WM-training. Cocaine use, impulsivity, and glutamate concentrations in the dACC and rACC using proton Magnetic Resonance Spectroscopy were assessed at baseline and after treatment. RESULTS Twenty-four participants completed the study, of which 9 received NAC and 15 received placebo. There were no baseline correlations of glutamate concentrations in the dACC or rACC with cocaine use measures or impulsivity. Additionally, there were no effects of NAC, WM-training, or the combination thereof on (changes in) glutamate concentrations in the dACC or rACC. DISCUSSION This randomized proof of concept study could not confirm our hypotheses. Possible explanations are insufficient power and the possible absence of deviant baseline glutamate concentrations in the included participants. Future studies should consider larger samples and a non-using control group to confirm baseline deviations in glutamate in cocaine users.
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Affiliation(s)
- Mieke H J Schulte
- Addiction, Development, and Psychopathology (ADAPT) Lab, Department of Psychology, University of Amsterdam, Amsterdam, the Netherlands; Amsterdam UMC, University of Amsterdam, Department of Psychiatry, Amsterdam Neuroscience, Meibergdreef 5, Amsterdam, Netherlands; Faculty of Movement and Behavioral Science, Department of Clinical, Neuro- and Developmental Psychology, Section of Clinical Psychology, VU University, Amsterdam, the Netherlands.
| | - Anna E Goudriaan
- Amsterdam UMC, University of Amsterdam, Department of Psychiatry, Amsterdam Neuroscience, Meibergdreef 5, Amsterdam, Netherlands; Arkin, Department of Research and Quality of Care, Amsterdam, the Netherlands
| | - Wouter J Boendermaker
- Addiction, Development, and Psychopathology (ADAPT) Lab, Department of Psychology, University of Amsterdam, Amsterdam, the Netherlands; Department of Experimental Psychology, Utrecht University, the Netherlands
| | - Wim van den Brink
- Amsterdam UMC, University of Amsterdam, Department of Psychiatry, Amsterdam Neuroscience, Meibergdreef 5, Amsterdam, Netherlands
| | - Reinout W Wiers
- Addiction, Development, and Psychopathology (ADAPT) Lab, Department of Psychology, University of Amsterdam, Amsterdam, the Netherlands
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Schulte MHJ, Aardoom JJ, Loheide-Niesmann L, Verstraete LLL, Ossebaard HC, Riper H. Effectiveness of eHealth Interventions in Improving Medication Adherence for Patients With Chronic Obstructive Pulmonary Disease or Asthma: Systematic Review. J Med Internet Res 2021; 23:e29475. [PMID: 34313593 PMCID: PMC8403699 DOI: 10.2196/29475] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 06/12/2021] [Accepted: 06/14/2021] [Indexed: 01/13/2023] Open
Abstract
Background Poor treatment adherence in patients with chronic obstructive pulmonary disease (COPD) or asthma is a global public health concern with severe consequences in terms of patient health and societal costs. A potentially promising tool for addressing poor compliance is eHealth. Objective This review investigates the effects of eHealth interventions on medication adherence in patients with COPD or asthma. Methods A systematic literature search was conducted in the databases of Cochrane Library, PsycINFO, PubMed, and Embase for studies with publication dates between January 1, 2000, and October 29, 2020. We selected randomized controlled trials targeting adult patients with COPD or asthma, which evaluated the effectiveness of an eHealth intervention on medication adherence. The risk of bias in the included studies was examined using the Cochrane Collaboration’s risk of bias tool. The results were narratively reviewed. Results In total, six studies focusing on COPD and seven focusing on asthma were analyzed. Interventions were mostly internet-based or telephone-based, and could entail telemonitoring of symptoms and medication adherence, education, counseling, consultations, and self-support modules. Control groups mostly comprised usual care conditions, whereas a small number of studies used a face-to-face intervention or waiting list as the control condition. For COPD, the majority of eHealth interventions were investigated as an add-on to usual care (5/6 studies), whereas for asthma the majority of interventions were investigated as a standalone intervention (5/7 studies). Regarding eHealth interventions targeting medication adherence for COPD, two studies reported nonsignificant effects, one study found a significant effect in comparison to usual care, and three reported mixed results. Of the seven studies that investigated eHealth interventions targeting medication adherence in asthma, three studies found significant effects, two reported nonsignificant effects, and two reported mixed effects. Conclusions The mixed results on the effectiveness of eHealth interventions in improving treatment adherence for asthma and COPD are presumably related to the type, context, and intensity of the interventions, as well as to differences in the operationalization and measurement of adherence outcomes. Much remains to be learned about the potential of eHealth to optimize treatment adherence in COPD and asthma.
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Affiliation(s)
- Mieke H J Schulte
- Department of Clinical, Neuro- and Developmental Psychology, Vrije Universiteit, Amsterdam, Netherlands
| | - Jiska J Aardoom
- Department of Clinical, Neuro- and Developmental Psychology, Vrije Universiteit, Amsterdam, Netherlands.,Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands.,National eHealth Living Lab, Leiden, Netherlands
| | - Lisa Loheide-Niesmann
- Department of Clinical, Neuro- and Developmental Psychology, Vrije Universiteit, Amsterdam, Netherlands.,Behavioural Science Institute, Radboud University, Nijmegen, Netherlands
| | - Leonie L L Verstraete
- Department of Clinical, Neuro- and Developmental Psychology, Vrije Universiteit, Amsterdam, Netherlands
| | | | - Heleen Riper
- Department of Clinical, Neuro- and Developmental Psychology, Vrije Universiteit, Amsterdam, Netherlands.,Department of Psychiatry, Amsterdam University Medical Center (VUmc), Vrije Universiteit, Amsterdam, Netherlands.,GGZ inGeest Specialized Mental Health Care, Research and Innovation, Amsterdam, Netherlands
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Zegers CML, Witteveen A, Schulte MHJ, Henrich JF, Vermeij A, Klever B, Dekker A. Mind Your Data: Privacy and Legal Matters in eHealth. JMIR Form Res 2021; 5:e17456. [PMID: 33729163 PMCID: PMC8075039 DOI: 10.2196/17456] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 05/01/2020] [Accepted: 01/17/2021] [Indexed: 01/30/2023] Open
Abstract
The health care sector can benefit considerably from developments in digital technology. Consequently, eHealth applications are rapidly increasing in number and sophistication. For successful development and implementation of eHealth, it is paramount to guarantee the privacy and safety of patients and their collected data. At the same time, anonymized data that are collected through eHealth could be used in the development of innovative and personalized diagnostic, prognostic, and treatment tools. To address the needs of researchers, health care providers, and eHealth developers for more information and practical tools to handle privacy and legal matters in eHealth, the Dutch national Digital Society Research Programme organized the “Mind Your Data: Privacy and Legal Matters in eHealth” conference. In this paper, we share the key take home messages from the conference based on the following five tradeoffs: (1) privacy versus independence, (2) informed consent versus convenience, (3) clinical research versus clinical routine data, (4) responsibility and standardization, and (5) privacy versus solidarity.
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Affiliation(s)
- Catharina M L Zegers
- Digital Society Health & Well-being, The Hague, Netherlands.,Institute of Data Science, Maastricht University, Maastricht, Netherlands.,Department of Radiation Oncology (MAASTRO), GROW - School for Oncology and Development Biology, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Annemieke Witteveen
- Digital Society Health & Well-being, The Hague, Netherlands.,Department of Biomedical Signals and Systems, TechMed Centre, University of Twente, Enschede, Netherlands
| | - Mieke H J Schulte
- Digital Society Health & Well-being, The Hague, Netherlands.,Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit, Amsterdam, Netherlands
| | - Julia F Henrich
- Digital Society Health & Well-being, The Hague, Netherlands.,Unit of Health, Medical and Neuropsychology, Institute of Psychology, Leiden University, Leiden, Netherlands
| | - Anouk Vermeij
- Digital Society Health & Well-being, The Hague, Netherlands.,Department of Cognitive Neuropsychology, Tilburg University, Tilburg, Netherlands
| | - Brigit Klever
- Digital Society Health & Well-being, The Hague, Netherlands.,University Medical Center, University of Groningen, Groningen, Netherlands
| | - Andre Dekker
- Digital Society Health & Well-being, The Hague, Netherlands.,Department of Radiation Oncology (MAASTRO), GROW - School for Oncology and Development Biology, Maastricht University Medical Centre, Maastricht, Netherlands
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Schulte MHJ, Kaag AM, Boendermaker WJ, van den Brink W, Goudriaan AE, Wiers RW. The effect of N-acetylcysteine and working memory training on neural mechanisms of working memory and cue reactivity in regular cocaine users. Psychiatry Res Neuroimaging 2019; 287:56-59. [PMID: 30991248 DOI: 10.1016/j.pscychresns.2019.03.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 03/20/2019] [Accepted: 03/20/2019] [Indexed: 12/23/2022]
Abstract
The current study investigated the combined effects of N-acetylcysteine and working memory (WM) training on behavioral and neural mechanisms of cue reactivity and WM in cocaine users in a randomized, double-blind design. Twenty-four of 38 cocaine-using men completed a 25-day treatment with either 2400 mg/day NAC or placebo. Both groups performed WM-training. During pre- and post-test lab-visits, neural mechanisms of cue reactivity and WM, and cue-induced craving and WM performance were assessed. Additionally, exploratory whole brain analyses were performed. Overall, the hypotheses were not confirmed, possibly due to small sample size, low WM-training adherence and/or ongoing substance use.
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Affiliation(s)
- Mieke H J Schulte
- Addiction, Development, and Psychopathology (ADAPT) lab, Department of Psychology, University of Amsterdam, Amsterdam, the Netherlands; Department of Psychiatry, Academic Medical Center, University of Amsterdam, the Netherlands; Faculty of Movement and Behavioral Science, Department of Clinical, Neuro-, and Developmental Psychology, Section of Clinical Psychology, VU University, Amsterdam, the Netherlands.
| | - Anne Marije Kaag
- Addiction, Development, and Psychopathology (ADAPT) lab, Department of Psychology, University of Amsterdam, Amsterdam, the Netherlands; Department of Psychiatry, Academic Medical Center, University of Amsterdam, the Netherlands
| | - Wouter J Boendermaker
- Addiction, Development, and Psychopathology (ADAPT) lab, Department of Psychology, University of Amsterdam, Amsterdam, the Netherlands; Department of Experimental Psychology, Utrecht University, the Netherlands
| | - Wim van den Brink
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, the Netherlands
| | - Anna E Goudriaan
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, the Netherlands; Arkin Mental Health, Amsterdam, the Netherlands
| | - Reinout W Wiers
- Addiction, Development, and Psychopathology (ADAPT) lab, Department of Psychology, University of Amsterdam, Amsterdam, the Netherlands
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7
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Schulte MHJ, Wiers RW, Boendermaker WJ, Goudriaan AE, van den Brink W, van Deursen DS, Friese M, Brede E, Waters AJ. Reprint of The effect of N-acetylcysteine and working memory training on cocaine use, craving and inhibition in regular cocaine users: correspondence of lab assessments and Ecological Momentary Assessment. Addict Behav 2018; 83:79-86. [PMID: 29661657 DOI: 10.1016/j.addbeh.2018.03.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Revised: 11/21/2017] [Accepted: 11/29/2017] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Effective treatment for cocaine use disorder should dampen hypersensitive cue-induced motivational processes and/or strengthen executive control. Using a randomized, double-blind, placebo-controlled intervention, the primary aim of this study was to investigate the effect of N-Acetylcysteine (NAC) and working memory (WM)-training to reduce cocaine use and craving and to improve inhibition assessed in the laboratory and during Ecological Momentary Assessment (EMA). The second aim was to examine correspondence between laboratory and EMA data. METHODS Twenty-four of 38 cocaine-using men completed a 25-day intervention with 2400mg/day NAC or placebo and WM-training as well as two lab-visits assessing cocaine use, craving and inhibition (Stop Signal task). Additionally, cocaine use, craving and cognition (Stroop task) were assessed using EMA during treatment, with 26 participants completing 819 assessments. RESULTS Cocaine problems according to the Drug Use Disorder Identification Test (DUDIT) decreased more after NAC than after placebo, and the proportion of cocaine-positive urines at lab-visit 2 was lower in the NAC group. No NAC effects were found on craving. For cocaine use and craving, results from the lab data were generally similar to EMA results. NAC also showed some effects on cognitive control: improved inhibition assessed with the Stop Signal task in the lab, and decreased classic Stroop performance during EMA. There were no significant effects of number of completed WM-training sessions. CONCLUSIONS Overall this study revealed mixed findings regarding the treatment of cocaine use disorders with NAC and WM-training. The effect of NAC on inhibition should be further investigated.
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Affiliation(s)
- Mieke H J Schulte
- Addiction, Development, and Psychopathology (ADAPT) Lab, Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands; Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
| | - Reinout W Wiers
- Addiction, Development, and Psychopathology (ADAPT) Lab, Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Wouter J Boendermaker
- Addiction, Development, and Psychopathology (ADAPT) Lab, Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands; Department of Experimental Psychology, Utrecht University, The Netherlands
| | - Anna E Goudriaan
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Arkin Mental Health, Amsterdam, The Netherlands
| | - Wim van den Brink
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Denise S van Deursen
- Addiction, Development, and Psychopathology (ADAPT) Lab, Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands; Faculty of Psychology and Educational Sciences, Open University of The Netherlands, Heerlen, The Netherlands
| | - Malte Friese
- Department of Psychology, Saarland University, Saarbruecken, Germany
| | - Emily Brede
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, MD, United States
| | - Andrew J Waters
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, MD, United States
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8
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Kaag AM, Schulte MHJ, Jansen JM, van Wingen G, Homberg J, van den Brink W, Wiers RW, Schmaal L, Goudriaan AE, Reneman L. The relation between gray matter volume and the use of alcohol, tobacco, cocaine and cannabis in male polysubstance users. Drug Alcohol Depend 2018; 187:186-194. [PMID: 29679913 DOI: 10.1016/j.drugalcdep.2018.03.010] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 02/12/2018] [Accepted: 03/06/2018] [Indexed: 02/03/2023]
Abstract
BACKGROUND Neuroimaging studies have demonstrated gray matter (GM) volume abnormalities in substance users. While the majority of substance users are polysubstance users, very little is known about the relation between GM volume abnormalities and polysubstance use. METHODS In this study we assessed the relation between GM volume, and the use of alcohol, tobacco, cocaine and cannabis as well as the total number of substances used, in a sample of 169 males: 15 non-substance users, 89 moderate drinkers, 27 moderate drinkers who also smoke tobacco, 13 moderate drinkers who also smoke tobacco and use cocaine, 10 heavy drinkers who smoke tobacco and use cocaine and 15 heavy drinkers who smoke tobacco, cannabis and use cocaine. RESULTS Regression analyses showed that there was a negative relation between the number of substances used and volume of the dorsal medial prefrontal cortex (mPFC) and the ventral mPFC. Without controlling for the use of other substances, the volume of the dorsal mPFC was negatively associated with the use of alcohol, tobacco, and cocaine. After controlling for the use of other substances, a negative relation was found between tobacco and cocaine and volume of the thalami and ventrolateral PFC, respectively. CONCLUSION These findings indicate that mPFC alterations may not be substance-specific, but rather related to the number of substances used, whereas, thalamic and ventrolateral PFC pathology is specifically associated with tobacco and cocaine use, respectively. These findings are important, as the differential alterations in GM volume may underlie different cognitive deficits associated with substance use disorders.
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Affiliation(s)
- A M Kaag
- Addiction, Development and Psychopathology (ADAPT) Lab, Department of Psychology, University of Amsterdam, The Netherlands; Department of Anatomy and Neurosciences, Center for Neurogenomics and Cognitive Research, Amsterdam Neuroscience, VU University Medical Center, The Netherlands; Amsterdam Brain and Cognition, University of Amsterdam, The Netherlands.
| | - M H J Schulte
- Addiction, Development and Psychopathology (ADAPT) Lab, Department of Psychology, University of Amsterdam, The Netherlands; Departement of Radiology and Nuclear Medicine, Amsterdam Neuroscience, Academic Medical Centre, Amsterdam, The Netherlands
| | - J M Jansen
- Departement of Psychiatry, Amsterdam Neuroscience, Academic Medical Centre, Amsterdam, The Netherlands; Leiden University, Faculty of Law, Institute for Criminal Law & Criminology, Leiden, The Netherlands
| | - G van Wingen
- Amsterdam Brain and Cognition, University of Amsterdam, The Netherlands; Departement of Psychiatry, Amsterdam Neuroscience, Academic Medical Centre, Amsterdam, The Netherlands
| | - J Homberg
- Donders Institute for Brain, Cognition, and Behaviour, Radboud University, Medical Centre, Nijmegen, The Netherlands
| | - W van den Brink
- Departement of Psychiatry, Amsterdam Neuroscience, Academic Medical Centre, Amsterdam, The Netherlands
| | - R W Wiers
- Addiction, Development and Psychopathology (ADAPT) Lab, Department of Psychology, University of Amsterdam, The Netherlands; Amsterdam Brain and Cognition, University of Amsterdam, The Netherlands
| | - L Schmaal
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia; Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia; Department of Psychiatry, Amsterdam Neuroscience, VU University Medical Center, Amsterdam, The Netherlands
| | - A E Goudriaan
- Amsterdam Brain and Cognition, University of Amsterdam, The Netherlands; Departement of Psychiatry, Amsterdam Neuroscience, Academic Medical Centre, Amsterdam, The Netherlands
| | - L Reneman
- Amsterdam Brain and Cognition, University of Amsterdam, The Netherlands; Departement of Radiology and Nuclear Medicine, Amsterdam Neuroscience, Academic Medical Centre, Amsterdam, The Netherlands
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9
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Schulte MHJ, Wiers RW, Boendermaker WJ, Goudriaan AE, van den Brink W, van Deursen DS, Friese M, Brede E, Waters AJ. The effect of N-acetylcysteine and working memory training on cocaine use, craving and inhibition in regular cocaine users: correspondence of lab assessments and Ecological Momentary Assessment. Addict Behav 2018; 79:24-31. [PMID: 29241082 DOI: 10.1016/j.addbeh.2017.11.044] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Revised: 11/21/2017] [Accepted: 11/29/2017] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Effective treatment for cocaine use disorder should dampen hypersensitive cue-induced motivational processes and/or strengthen executive control. Using a randomized, double-blind, placebo-controlled intervention, the primary aim of this study was to investigate the effect of N-Acetylcysteine (NAC) and working memory (WM)-training to reduce cocaine use and craving and to improve inhibition assessed in the laboratory and during Ecological Momentary Assessment (EMA). The second aim was to examine correspondence between laboratory and EMA data. METHODS Twenty-four of 38 cocaine-using men completed a 25-day intervention with 2400mg/day NAC or placebo and WM-training as well as two lab-visits assessing cocaine use, craving and inhibition (Stop Signal task). Additionally, cocaine use, craving and cognition (Stroop task) were assessed using EMA during treatment, with 26 participants completing 819 assessments. RESULTS Cocaine problems according to the Drug Use Disorder Identification Test (DUDIT) decreased more after NAC than after placebo, and the proportion of cocaine-positive urines at lab-visit 2 was lower in the NAC group. No NAC effects were found on craving. For cocaine use and craving, results from the lab data were generally similar to EMA results. NAC also showed some effects on cognitive control: improved inhibition assessed with the Stop Signal task in the lab, and decreased classic Stroop performance during EMA. There were no significant effects of number of completed WM-training sessions. CONCLUSIONS Overall this study revealed mixed findings regarding the treatment of cocaine use disorders with NAC and WM-training. The effect of NAC on inhibition should be further investigated.
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Affiliation(s)
- Mieke H J Schulte
- Addiction, Development, and Psychopathology (ADAPT) Lab, Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands; Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
| | - Reinout W Wiers
- Addiction, Development, and Psychopathology (ADAPT) Lab, Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Wouter J Boendermaker
- Addiction, Development, and Psychopathology (ADAPT) Lab, Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands; Department of Experimental Psychology, Utrecht University, The Netherlands
| | - Anna E Goudriaan
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Arkin Mental Health, Amsterdam, The Netherlands
| | - Wim van den Brink
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Denise S van Deursen
- Addiction, Development, and Psychopathology (ADAPT) Lab, Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands; Faculty of Psychology and Educational Sciences, Open University of The Netherlands, Heerlen, The Netherlands
| | - Malte Friese
- Department of Psychology, Saarland University, Saarbruecken, Germany
| | - Emily Brede
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, MD, United States
| | - Andrew J Waters
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, MD, United States
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10
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Schulte MHJ, Goudriaan AE, Kaag AM, Kooi DP, van den Brink W, Wiers RW, Schmaal L. The effect of N-acetylcysteine on brain glutamate and gamma-aminobutyric acid concentrations and on smoking cessation: A randomized, double-blind, placebo-controlled trial. J Psychopharmacol 2017; 31:1377-1379. [PMID: 28922968 PMCID: PMC5639948 DOI: 10.1177/0269881117730660] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Using data form a 14-day double-blind trial with 48 smokers randomized to either N-acetylcysteine (2400 mg) or placebo, we tested the effect of N-acetylcysteine on glutamate and gamma-aminobutyric acid concentrations in the dorsal anterior cingulate cortex and on smoking cessation. Smoking related behaviors and neurotransmitter concentrations in the dorsal anterior cingulate cortex were assessed before and after treatment. Forty-seven non-smoking males served as baseline controls. Smokers showed higher baseline glutamate but similar gamma-aminobutyric acid concentrations than non-smokers. There were no treatment effects on dorsal anterior cingulate cortex neurotransmitter concentrations, smoking cessation, craving, or withdrawal symptoms. These results confirm glutamate disbalance in smokers, but not efficacy of N-acetylcysteine.
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Affiliation(s)
- MHJ Schulte
- Addiction, Development, and Psychopathology (ADAPT) Laboratory, University of Amsterdam, Amsterdam, the Netherlands,Amsterdam Institute for Addiction Research, University of Amsterdam, Amsterdam, the Netherlands,Mieke HJ Schulte, Department of Psychology, University of Amsterdam, Nieuwe Achtergracht 129B, 1018WS, Amsterdam, the Netherlands.
| | - AE Goudriaan
- Amsterdam Institute for Addiction Research, University of Amsterdam, Amsterdam, the Netherlands,Arkin Mental Health, Amsterdam, the Netherlands
| | - AM Kaag
- Addiction, Development, and Psychopathology (ADAPT) Laboratory, University of Amsterdam, Amsterdam, the Netherlands,Amsterdam Institute for Addiction Research, University of Amsterdam, Amsterdam, the Netherlands
| | - DP Kooi
- Amsterdam Institute for Addiction Research, University of Amsterdam, Amsterdam, the Netherlands
| | - W van den Brink
- Amsterdam Institute for Addiction Research, University of Amsterdam, Amsterdam, the Netherlands
| | - RW Wiers
- Addiction, Development, and Psychopathology (ADAPT) Laboratory, University of Amsterdam, Amsterdam, the Netherlands
| | - L Schmaal
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Australia,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia,Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, the Netherlands
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11
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Schulte MHJ, Kaag AM, Wiers RW, Schmaal L, van den Brink W, Reneman L, Homberg JR, van Wingen GA, Goudriaan AE. Prefrontal Glx and GABA concentrations and impulsivity in cigarette smokers and smoking polysubstance users. Drug Alcohol Depend 2017; 179:117-123. [PMID: 28763779 DOI: 10.1016/j.drugalcdep.2017.06.025] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 06/12/2017] [Accepted: 06/12/2017] [Indexed: 12/22/2022]
Abstract
Glutamate and GABA play an important role in substance dependence. However, it remains unclear whether this holds true for different substance use disorders and how this is related to risk-related traits such as impulsivity. We, therefore, compared Glx (as a proxy measure for glutamate) and GABA concentrations in the dorsal anterior cingulate cortex (dACC) of 48 male cigarette smokers, 61 male smoking polysubstance users, and 90 male healthy controls, and investigated the relationship with self-reported impulsivity and substance use. Glx and GABA concentrations were measured using proton Magnetic Resonance Spectroscopy. Impulsivity, smoking, alcohol and cocaine use severity and cannabis use were measured using self-report instruments. Results indicate a trend towards group differences in Glx. Post-hoc analyses showed a difference between smokers and healthy controls (p=0.04) and a trend towards higher concentrations in smoking polysubstance users and healthy controls (p=0.09), but no differences between smokers and smoking polysubstance users. dACC GABA concentrations were not significantly different between groups. Smoking polysubstance users were more impulsive than smokers, and both groups were more impulsive than controls. No significant associations were observed between dACC neurotransmitter concentrations and impulsivity and level and severity of smoking, alcohol or cocaine use or the presence of cannabis use. The results indicate that differences in dACC Glx are unrelated to type and level of substance use. No final conclusion can be drawn on the lack of GABA differences due to assessment difficulties. The relationship between dACC neurotransmitter concentrations and cognitive impairments other than self-reported impulsivity should be further investigated.
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Affiliation(s)
- Mieke H J Schulte
- Addiction, Development, and Psychopathology (ADAPT) lab, Department of Psychology, University of Amsterdam, The Netherlands; Department of Psychiatry, Academic Medical Center, University of Amsterdam, The Netherlands.
| | - Anne Marije Kaag
- Addiction, Development, and Psychopathology (ADAPT) lab, Department of Psychology, University of Amsterdam, The Netherlands; Department of Psychiatry, Academic Medical Center, University of Amsterdam, The Netherlands
| | - Reinout W Wiers
- Addiction, Development, and Psychopathology (ADAPT) lab, Department of Psychology, University of Amsterdam, The Netherlands
| | - Lianne Schmaal
- Department of Psychiatry and Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - Wim van den Brink
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, The Netherlands
| | - Liesbeth Reneman
- Department of Radiology and Nuclear Medicine, Academic Medical Center, University of Amsterdam, The Netherlands; Amsterdam Brain and Cognition, University of Amsterdam, Amsterdam, The Netherlands
| | - Judith R Homberg
- Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Centre, The Netherlands
| | - Guido A van Wingen
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, The Netherlands; Spinoza center for Neuroimaging, Institute of the Royal Netherlands Academy of Arts and Sciences, Amsterdam, The Netherlands; Amsterdam Brain and Cognition, University of Amsterdam, Amsterdam, The Netherlands
| | - Anna E Goudriaan
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, The Netherlands; Arkin Mental Health, Amsterdam, The Netherlands
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